Memorial expanding mental health services at doctors' offices

Dean Olsen

Sunday

Sep 29, 2013 at 12:01 AMSep 29, 2013 at 12:26 PM

Seventeen-year-old Jessica Brown credits Kari Welch, a counselor in the office of her longtime pediatrician, for helping her emerge from the bondage of an anxiety disorder. Therapy in a comfortable, confidential setting that promotes communication between behavioral health specialists, doctors and others in a primary care medical home can reach many people who otherwise would delay or avoid treatment for mental illness, Memorial Health System officials say.

Seventeen-year-old Jessica Brown credits Kari Welch, a counselor in the office of her longtime pediatrician, for helping her emerge from the bondage of an anxiety disorder.

“She inspired me,” said Brown, a Springfield resident and junior at Springfield Learning Academy who has received counseling from Welch at Memorial Physician Services’ Koke Mill site since February.

Before that counseling relationship began, Brown said, “I was living in a dark and not awesome place. I felt like I was going to be a hermit in my mom’s basement when I grew up.”

Therapy in a comfortable, confidential setting that promotes communication between behavioral health specialists, doctors and others in a primary care medical home can reach many people who otherwise would delay or avoid treatment for mental illness, Memorial Health System officials say.

The not-for-profit system, which operates Memorial Medical Center as well as physicians’ offices in Springfield and surrounding rural areas, began placing counselors in its clinics in 2008. The system is among a growing number of U.S. health care providers integrating mental health services in an almost seamless model to benefit patients’ minds and bodies.

“Stress causes illness, so if we don’t manage the stress, it will become illness,” said Dr. Virginia Dolan, Brown’s pediatrician and one of five pediatricians Welch works with at Memorial Physician Services-Koke Mill.

Counselors that are “embedded” in primary care clinics, giving patients access to more in-depth services than most physicians have the time or expertise to provide, is “becoming more of a norm,” said Dr. Renee Poole, a family physician at a clinic for low-income patients on Chicago’s South Side.

Poole, a vice president with the Illinois Academy of Family Physicians, refers many patients to such a counselor in her clinic rather than sending them to other professionals elsewhere in Chicago.

The delays and emotional challenges that can be associated with setting up appointments and paying counselors, social workers or psychologists in offices unfamiliar to patients are daunting, Poole said.

Making mental health care more accessible is even more important now in Illinois after state funding cuts have reduced options for patients, she said.

By treating depression and anxiety, counselors can make it more likely patients will take medicine prescribed for chronic illnesses such as diabetes, exercise regularly, eat better and address other challenges in their lives, Poole said.

“When you have a sense of helplessness and hopelessness, you don’t want to take control of your life,” she said.

MOSAIC Project

Welch has worked since early 2013 with about 100 pediatric patients as part of the Children’s MOSAIC Project, a plan to transform the way mental health care is provided to children in Springfield.

The project has been funded since 2011 with about $2 million from the Illinois Children’s Healthcare Foundation to a Memorial Health System affiliate, Mental Health Centers of Central Illinois.

In addition to Welch’s services to Memorial Physician Services patients, the MOSAIC Project involves work in neighborhoods and schools. A counselor similar to Welch serves children and families through the project at Southern Illinois University’s Center for Family Medicine.

Funding for the positions is winding down, but Memorial plans to continue the services and bill patients’ insurance plans for the counselors’ services, said Vern Reinert, manager of Memorial Counseling Associates.

Memorial also bills for counselors’ services at other clinics.

Memorial began mental health services in primary care clinics at its Lincoln site in 2008 after receiving requests for help from the doctors working there, said Susan Shull, a registered nurse and Memorial Physician Services regional administrator.

In addition to the financial challenges that may be associated with getting counseling, patients in rural areas generally live far from specialists, she said.

Counseling services were added at the system’s Petersburg clinic in 2011.

Hours that counselors were available to patients expanded as Memorial put in place a research-based counseling model known as Impact in early 2012 with the help of a $56,000 grant from the Memorial Medical Center Foundation, Shull said.

The model emphasizes a team approach — involving nurses and doctors — in meeting patients’ needs.

“Traditionally, therapy has been kind of a stand-alone service, and it just creates a lot of barriers,” Shull said. “The Impact model prescribes care based on how the person is responding to treatment.”

With Impact, Reinert said, “You have a great deal of emphasis on the patient as part of that team. Rather than care just happening to that patient, the patient needs to take a role. It’s important for them to learn about their illness, to learn their disease and how it impacts them and what they can do to make some change.”

Skills for a lifetime

Cindy Fedor, a social worker and “care manager” who counsels patients at the Lincoln clinic, said she focuses on “teaching patients skills they can use for a lifetime.”
Those skills can be as basic as daily hygiene, adequate sleep and balanced meals, but they can make a big difference in a person’s mental health, she said.

Fedor enjoys being introduced to patients by their primary care doctors, which helps to build trust in the relationship. Over five to eight hour-long sessions with patients, she uses worksheets and other problem-solving tools to “look at changing behavior,” she said. “Your focus becomes the symptoms.”

Fedor said she has gotten satisfaction from seeing patients’ outlooks improve.

“I love empowering people to have the skills they need to be successful,” she said.

Dr. Christopher Rivera, a family physician, said the availability of on-site mental health services helped influence his decision a few years ago to base his practice at the Lincoln site.

The option of referring a patient to Fedor is “a huge weight off your shoulders,” Rivera said, “because medicine can only do so much.”

He sometimes encounters resistance when he suggests counseling to patients. The stigma surrounding mental health issues and mental illness has decreased in recent decades but still remains, he said.

“People tend to have the idea that counseling is … for people who are crazy,” he said.

Rivera sometimes will require that patients meet with Fedor before he will write or continue a prescription for depression or anxiety medicine.

Fedor said many patients’ stereotypes about counseling are erased after they go through the first session. “My approach is very education-focused,” she said.

Patients appreciate the confidentiality of getting counseling services at their doctor’s office, she added.

Rivera has seen quite a few of his patients’ overall health improve after counseling. They are more upbeat, have lower cholesterol readings and are getting better sleep, he said.

Hundreds of patients have received mental health services at Memorial’s Lincoln and Petersburg sites. Success — measured by reduced depression and related symptoms — has prompted Memorial to recently hire a part-time therapist for its Chatham site. There are plans to hire two full-time therapists for its Jacksonville clinic.

Memorial also is adding a second therapist for the Lincoln clinic.

One of the therapists in Jacksonville will serve children. The other therapists at the clinics in Lincoln, Petersburg and Jacksonville work only with adults.

At the Koke Mill site, Dolan and Welch said they believe the counseling services have actually saved lives by averting suicides among teens.

At the Koke Mill site, Brown, the 17-year-old, found that it was easy for her counselor to communicate with her doctor to tweak the type of anti-anxiety medicine she should receive. That communication, and a good relationship with Welch, has helped Brown better deal with anxiety problems that have plagued her for years.

Talking with Welch helps relieve stress, Brown said. “It feels like having a conversation with a friend,” she said.

Though her anxiety disorder isn’t cured, Brown feels confident that she will be able to fulfill her dream of becoming a cosmetologist. Brown’s mother, Paula Clark, couldn’t be happier.

“My daughter has come out of her shell more in the past six months than during the nine years we’ve been going through treatment,” Clark said. “This was a godsend to our family. I pray that more doctors’ offices offer this treatment option for children.”

Dean Olsen can be reached at 788-1543. Follow him at twitter.com/DeanOlsenSJR.

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